Kim Sunley

Chapter Contents

Introduction

It seems incongruous that a service set up to provide emergency care sometimes causes harm to the staff involved in delivering that care. In 2003, the National Audit Office carried out a survey on health and safety risks to staff in the NHS in England (National Audit Office 2003a). They reported that there were 135 172 staff accidents in 2001–2, with wide variations between similar Trusts in the number of accidents per 1000 staff. They also highlighted that there is significant under-reporting, so the true figure is likely to be much higher. In 2009 a comprehensive review into the health and well-being of the NHS workforce found that NHS staff have a greater propensity to work-related illness or accident than other comparative groups (Department of Health 2009). This is despite the complex set of statutes and regulations, some based on European legislation, designed to provide a safe environment for employees and others, such as patients, visitors, contractors’ employees and agency staff. This chapter considers various aspects of accidents at work, describes the main legal responsibilities of employers and employees, and also how this legislation is applied to hazards found in emergency departments (EDs).

Preventing accidents

The Health and Safety Executive (1993) use the term ‘accident’ to refer to any unplanned event that results in injury or ill health of people, or damage or loss to property, plant, materials or the environment, or a loss of business opportunity. Before any action can be taken to prevent accidents, the causes must be identified. Causes can be divided into unsafe conditions (e.g., wet floors, trailing cables, insufficient manual handling aids, faulty equipment) or unsafe acts (e.g., nurses’ failure to wear protective equipment or ignoring safety instructions). Unsafe acts arise from lack of training or nurses’ attitudes towards their own safety (Lynch & Cole 2006). Workplaces should be regularly inspected to check that hazards do not exist and, although trade union safety representatives have this as part of their role, it should be a cooperative process between staff, managers and safety representatives. Local policies should encourage nurses to report hazards before accidents occur so that preventive action may be taken. In fact there is a specific duty contained within the Management of Health and Safety at Work Regulations 1999 (Health & Safety Executive 2000) that requires employees to report to their employer details of any work situation that might represent a serious and imminent danger.

If an accident does occur, accurate records are needed. From the employer’s point of view there is a duty to report certain types of accidents defined within the Reporting of Injury, Diseases and Dangerous Occurrence Regulations (RIDDOR) (1995) to the Health and Safety Executive. Failure to do so is a criminal offence. The employer needs information about an accident so the event can be investigated to prevent its recurrence and risk assessments can be reviewed. Employees are obliged to report accidents and it is in their interests to accurately complete accident forms and accident books to protect themselves in the event of future loss of income or long-term effects of injury or disease.

It has always been difficult to arrive at the true costs of accidents, and yet this information could provide an incentive to tackling the problem of workplace accidents by providing a measurement against which financial loss can be judged. The National Audit Office (2003a) survey of health and safety in hospitals estimated that accidents cost the NHS ≤173 million in England alone. This is a crude estimate and does not include staff replacement costs, medical treatment costs or court compensation, so the true costs are likely to be much higher. The cost of an accident is directly related to the outcome of that accident, but this can be difficult to predict, as, for example, a needlestick injury may or may not result in a nurse contracting a blood-borne virus such as hepatitis C. The total cost of accidents must include the cost of maintaining a safe environment. A relationship exists between underlying safety control and accident occurrence.

Implementing safety controls will involve some cost, such as staff communication and training, physical protection (alarm systems), publicity campaigns, time spent in risk assessment, inspecting the workplace for hazards and maintenance of equipment. These costs will be offset by the direct and indirect costs resulting from accidents and ill health, such as occupational sick pay, equipment damage, disruption in patient care, damage to the environment, costs of replacement staff and costs of litigation. The management responsibility is to reduce risks as far as is ‘reasonably practicable’, a term used in health and safety law that is a balance between the level of risk and the time, trouble and money needed to control it.

Legislation

The health service was not covered by any health and safety legislation until 1974 when the Health & Safety at Work etc. Act was passed. This is still the major legislative power and any new regulations come under its framework. The Health & Safety at Work etc. Act (1974) specifies the duties of the employer with the general requirement to ‘ensure, so far as is reasonably practicable, the health, safety & welfare at work of all his Employees’ (Section 2(1)). The Act then specifies the particular areas where this duty applies (Box 40.1).

Another section of the Health & Safety at Work etc. Act (1974) defines the duty of the employer to non-employees, including patients, visitors and contractors’ employees, to ensure these people are also protected from harm whilst they are on the premises. Systems of work must be developed to protect these groups. Floor cleaning is an example of the need to ensure that staff and others are prevented from walking on wet, slippery floors by cleaning during quiet periods, temporarily rerouting pedestrian walkways or the use of cones and warning signs.

The approach to health and safety legislation is to involve both employers and employees. The Health & Safety at Work etc. Act (1974) specifies that all employees must take reasonable care for the health and safety of themselves and others who may be affected by their acts or omissions and cooperate with the employer to enable compliance with statutory requirements. If the employer provides any protective equipment, such as gloves, goggles or aprons, the employee must wear it. This presumes the employer has defined the need for the equipment, the equipment is suitable and the employer has trained staff in the correct use.

The Health & Safety at Work etc. Act (1974) is a wide-ranging piece of legislation and one that permits further regulations to be developed that refer to specific aspects of health and safety. In 1992, six new sets of regulations were enacted that were based on EC Directives (Health & Safety Executive 1992a–e), but during that period, 1974–1995, other regulations included:

In the case of disease, the nature of the work is specified. Hepatitis B infection is a reportable disease for anyone who comes into contact with blood, blood products or body secretions. The regulations specify the type of dangerous occurrences that must be reported, whether or not anyone has been injured. Similarly, the specific types of injury are defined along with a broad category of any injury that results in absence from work for seven days or more. The other reportable major injuries are outlined in Box 40.2. Any incidents where a staff member has a needlestick injury where the sharp was known to be contaminated with infected blood must be reported to the Health and Safety Executive under RIDDOR.

Legislation since 1992

Health and safety is an issue that has featured prominently in European legislation. Article 118A of the Single European Act 1986 (European Union 1986) states that member states shall pay particular attention to encouraging improvements especially in the working environment as regards the health and safety of workers and shall set as their objective the harmonization of conditions in this area, whilst maintaining the improvements made.

Directly arising out of this article was a framework directive (EC Directive 89/391/EEC 1989) on health and safety, with a number of so-called ‘daughter directives’ covering manual handling, personal protective equipment, work equipment, the workplace, temporary workers and display-screen equipment. Once these directives were agreed, European Union member states were required to include the provisions of the directives into their own law by 1992. In the UK, this resulted in a set of regulations often referred to as ‘the six pack’, comprising: